Conservative management of significant epidural haematomas

Abstract

Abstract Background Extradural haematomas form 0.5% of all head injuries (Narayan and Kempisy, Principles of Neurosurgery, 2005). With the extensive blood supply to the vein, injury to the meningeal arteries leads to rapid intracranial bleeding of significant amounts of blood. These patients have traditionally been treated with urgent surgical evacuation of the haematoma to relieve the compression of the brain and brain stem (Bricolo and Pasaut, Neurosurgery 14:8-12, 1984). With the routine use of computed tomography (CT) for management of head injury patients, non-operative management is being used more often in selected patients (Narayan and Kempisy, Principles of Neurosurgery, 2005; Bricolo and Pasaut, Neurosurgery 14:8-12, 1984; Dubey et al., Neurol India 52:443-445, 2004; Offner et al., Am J Surg 192:801-805, 2006). If this can be shown as a suitable alternative to surgical intervention, it will offer a mode of treatment that has fewer potential complications and risks than the traditional surgical route. Methods The authors report 50 patients who had an extradural haematoma on computed tomographic scanning and did not need surgical treatment. This was during the last 3 years at Assiut University Hospital. During the same period, there were another 270 patients who had an extradural haematoma and all of them needed surgical treatment. This study is limited only to the 50 patients who did not require surgery. A CT scan was done 24–48 h after the head injury. All the 50 patients had minimal symptoms and signs which were headache and rarely vomiting but no loss of consciousness, and none of the patients had papilloedema. Results All the 50 patients were managed conservatively, being kept under neurosurgical care and were followed up by serial CT scanning. Their condition was either static or improving. None of the 50 patients needed surgery. They all made a complete recovery and showed resolution of the haematoma on CT scanning. This was over a period of 4–15 weeks. Conclusion Radiologically significant extradural haematomas can be treated conservatively. This depends on the neurological state of the patient rather than the size of the extradural haematoma. When conservative treatment is considered, adequate neurological observation is mandatory.

Keywords

• Extradural haematoma
• Head injury
• Skull